Evaluation of bronchoscopy and 18F-FDG PET-CT in a fast track assessment of suspected lung cancer

Abstract

Introduction: The aim of this study was to evaluate the clinical performance of bronchoscopy and 18F- FDG PET-CT in an outpatient fast track assessment for suspected lung cancer. Methods: We evaluated 215 patients who were referred to our hospital between December 2007 and November 2010, due to an abnormal chest X-ray and a clinical suspicion of pulmonary malignancy. The fast track consists of blood sampling, pulmonary function tests, whole body 18F-FDG-PET/CT scan and bronchoscopy on a single day. The results of these modalities were discussed in a multidisciplinary setting, with histopathological evaluation as the reference standard whenever available. Results: In 195 patients (91%) a histologically proven diagnosis was made. In 85 % of these a malignancy was diagnosed. In the group with histologically proven malignancy, a complete bronchoscopy was performed in 91 %. In this group, histological diagnosis was achieved in 50 % by bronchoscopy. In all other cases, malignancy was proven by CT guided biopsy, ultrasound guided biopsy or surgery. In the group of patients with a tumor positive bronchoscopy 18FFDG- PET/CT revealed lymph node metastases or distant metastases in 75 % at locations which were more attractive for biopsy than bronchoscopy Conclusion: Bronchoscopy reveals a histologically proven malignancy in 50 % of cases. 18F-FDGPET/ CT showed more attractive locations for biopsy in the majority of these patients. Therefore, routine use of bronchoscopy can be debated, because of the invasive manner of the procedure and its very limited role in staging. An 18F-FDGPET/ CT should be considered as a first step in PET guided biopsy preventing unnecessary bronchoscopy.